A cross-sectional study was performed on 1527 Thai women, 1270 of whom had received from one to twenty-five consecutive 3-month contraceptive injections of 150 mg of depo medroxyprogesterone acetate (DMPA) and a monthly oral oestrogen supplement. Analysis of data revealed that use of DMPA and breast nodules are independent.

In Bangladesh, like other developing countries, most births occur at home or in the community, so logistic problems and taboos prevent the weighing of every newborn child. This study was performed to see whether other simpler measurements could be substituted for weight to identify neonates of low birth weight. A total of 1676 live births at the Chittagong Medical College Hospital constituted the study sample, and this showed a high correlation between mid-arm circumference and birth weight (r=0.792, p<0·000). A mid-arm circumference of <9·0 cm had the best sensitivity and specificity for identifying newborns with a birth weight of less than 2500 g. These neonates were followed up to record neonatal deaths. Neonatal mortality showed an inverse relation with mid-arm circumference. A mid-arm circumference of <9·0 cm and a birth weight of <2500 g were equally useful in predicting neonatal outcome. Mid-arm circumference is a simple, quick and reliable indicator for predicting low birth weight and neonatal outcome, and can be easily measured by medical practitioners and traditional birth attendants (TBAs) in the community of developing countries like Bangladesh.

China's one-child policy has been quite successful in bringing down the country's fertility level but has produced a large number of one-child families. The risk of one-child families losing their only child has not received enough attention. In this paper, using an extension of Goldman & Lord (1983)'s method to measure widowhood, period life-table data from China's 2000 population census are used to examine age-specific and cumulative probabilities of mothers losing their only child. It is found that a mother faces a 14.94% probability of losing a son, and 12.21% probability of losing a daughter. As the age of first-time mothers increases, the probability of losing a child declines. Urban and rural mothers have different indices regarding the loss of children. Based on these findings the prospects for China's one-child policy are discussed.

Twenty-three girls and thirteen boys, aged between 4 and 9 years, gave urine samples which were measured by HPLC for adrenaline, noradrenaline, cortisol and cortisone on a school day and on a home day. Home levels of noradrenaline, cortisol and cortistone were consistently higher than school levels. Cortisol was positively correlated with adrenaline and noradrenaline at home, but not at school. These results may suggest that the school day represents a stimulating but comparatively structured environment with little negative affect, while the home day is characterised by stimulation but relative uncertainty in social interactions.

All 8th-form schoolgirls from the municipality of Odense in Denmark were asked at what age they reached menarche, and 886 girls (97·6%) gave this information. There is no evidence for seasonality in the time of birth but for far more girls than expected menarche occurred during winter or summer and fewer than expected during spring and autumn. This pattern appears primarily in girls living in the suburbs and was not seen in those living in central Odense. The seasonality appears to be brought about by differences in mean age at menarche according to time of the year at birth.

There is a general consensus in the literature that fertility differences between populations can be accounted for by differences in just four key proximate determinants: nuptiality, the postpartum non-susceptible period, contraception and abortion. Natural fecundibility is generally assumed to be constant between populations. This paper puts the theoretical and empirical case for a re-evaluation of that assumption, drawing on the under-utilized data on sexual activity collected in the Demographic Health Surveys (DHSs). Using data for married women in nine African countries, the analysis finds substantial population level differences in mean monthly coital frequency, which, if accurate, suggest an important demographic effect. There is a clear regional patterning to these differences, with levels of activity considerably lower among women in the West African populations included in the study than those from East and southern Africa. For West Africa in particular the data indicate the normality of exceptionally long periods of very infrequent or no intercourse by married women outside the period of postpartum abstinence. The findings challenge prevailing presumptions concerning susceptibility to pregnancy in marriage on which statistics for unmet need for family planning are derived. While doubts are raised over the precision of the sexual activity data used, the paper argues for the need for a greater effort to operationalize the ‘proximate determinant of conception’, not only for more accurate fertility modelling, but also as a planning tool for a more sensitive provision of family planning services in Africa.

The objective of this study was to analyse the association between socioeconomic indicators and cardiovascular disease risk factors in adult residents of Rio de Janeiro city, Brazil. Data were obtained by direct interview and physical examination in a population-based cross-sectional study in the city of Rio de Janeiro, 1995–96. Subjects were selected by two-stage random sampling and information was collected on socioeconomic, anthropometric and demographic characteristics, as well as on existing risk factors for cardiovascular disease. An index to express the risk of cardiovascular disease (CVD) was built, based on the presence of two or more of the following risk factors: overweight (measured by the body mass index, BMI), fat location (measured by the waist–hip ratio index, WHR), smoking, hypertension, sedentary lifestyle and alcohol consumption. The association between this risk index and the socioeconomic variables level of schooling, per capita income and residence location (slum vs non-slum) was evaluated through logistic regression models that controlled for the age of the subjects. Two separate models were built, according to the gender of the subjects. Complete data were collected for 1413 males and 1866 females over the age of 20 years (82% of the intended sample). In the studied population, a considerable prevalence of risk for CVD was found: 42·2% among males and 65·4% among females. For males, the socioeconomic and demographic indicators retained in the logistic model were age (OR 1·01, 95% CI 1·00–1·01), level of schooling (1·77, 95% CI 1·39–2·26) and per capita income (OR 0·77, 95% CI 0·61–0·97). For females, the indicators retained were age (OR 1·02, 95% CI 1·01–1·02) and level of schooling (OR 2·26, 95% CI 1·84–2·77). The findings indicate that cardiovascular disease risk is already an alarming problem in the urban populations of developing countries, and that educational level is the most important socioeconomic factor associated with its presence.

Recent evidence indicates a rising trend in premarital sexual activity among young people in Iran. However, little is known about the extent to which young people’s sexual behaviours expose them to HIV and STI risks. This study aimed to assess HIV/STI-related sexual risk-taking behaviours (correlates and determinants) and HIV/STI risk perception among male university students in Tehran. A representative sample of male university students (N=1322) studying in government and private Tehran universities completed an anonymous questionnaire survey in 2013–14. Respondents were selected using two-stage stratified cluster sampling. About 35% of respondents had ever had premarital sex (n=462). The majority (about 85%) of the sexually experienced students reported having multiple sexual partners in their lifetime. More than half (54%) reported inconsistent condom use over the previous month. Despite this exposure to HIV/STI risk, the respondents had a very low level of HIV/STI risk perception. Only 6.5% were highly concerned about contracting HIV over the previous year, and an even lower percentage (3.4%) were concerned about contracting STIs in the near future. Early sexual debut (<18 years), studying in a private university, ever watching pornography and work experience were found to be significant predictors of having multiple sexual partners. Younger age at sexual debut, having one lifetime sexual partner and poor HIV knowledge were significant predictors of inconsistent condom use over the preceding month. HIV prevention programmes among Iranian youth need to focus on the postponement of first sex and enhancement of HIV/STI knowledge in the light of increasing access of young people to pornography.

There is nothing new about the belief that the spread of education with its influence on knowledge and outlook is a central force behind the demographic transition. In 1934 Penrose wrote: ‘when a community has gained the knowledge and acquired the habits necessary to reduce the death rate it will sooner or later gain the knowledge and acquire the habits necessary to reduce the birth rate. There may be time lag between the two processes, but both of them in a large share are the outcome of education’ (Penrose, 1934). It is thus surprising that investigation of the specific influence of parental education on the mortality of children in developing countries was neglected until Caldwell's (1979) analysis of survey data from Ibadan, Nigeria, which demonstrated that mother's education was a more decisive determinant of child survival than other family characteristics such as husband's occupation and education. Other studies followed this influential investigation. The greater contribution to mortality decline of educational advance compared to health care provision, it has been argued, is a contribution to the development versus medical technology debate (Mosley, 1985). Inevitably the beginnings of a counter-reaction may be discerned. Caldwell (1986) stressed that the influence of education should not be considered in isolation from the wider context, while Cooksey et al. (1986, unpublished) consider that the effect of maternal education may have been exaggerated.

The effect of lactation on menstrual cycles, ovulation and conception was studied in a group of non-contracepting Amerindian Mopan Mayan women. Anthropological observations of relevant events were made over a 21-month period. Blood samples were assayed to determine the plasma concentrations of prolactin, luteinising hormone, follicle stimulating hormone, human chorionic gonadotrophin, placental lactogen, oestrogen, progesterone and cortisol. The data show that: frequent and prolonged breast-feeding was associated with a marked increase in plasma prolactin concentrations to levels similar to those in lactating Gaing but higher than those in lactating Scottish women; ovulatory menstrual cycles and pregnancy occurred during frequent lactation; in lactating menstruating women there was an inverse correlation between fat weight and months post-partum. These data suggest that other factors as well as suckling account for the effects of lactation on fecundity.

This study uses three key anthropometric measures of nutritional status among children (stunting, wasting and underweight) to explore the dual effects of household composition and dependency on nutritional outcomes of under-five children in Ghana. The objective is to examine changes in household living arrangements of under-five children to explore the interaction of dependency and nucleation on child health outcomes. The concept of nucleation refers to the changing structure and composition of household living arrangements, from highly extended with its associated socioeconomic system of production and reproduction, social behaviour and values, towards single-family households – especially the nuclear family, containing a husband and wife and their children alone. A negative relationship between levels of dependency, as measured by the number of children in the household, and child health outcomes is premised on the grounds that high dependency depletes resources, both tangible and intangible, to the disadvantage of young children. Data were drawn from the last four rounds of the Ghana Demographic and Health Surveys (GDHSs), from 1993 to 2008, for the first objective – to explore changes in household composition. For the second objective, the study used data from the 2008 GDHS. The results show that, over time, households in Ghana have been changing towards nucleation. The main finding is that in households with the same number of dependent children, in nucleated households children under age 5 have better health outcomes compared with children under age 5 in non-nucleated households. The results also indicate that the effect of dependency on child health outcomes is mediated by household nucleation and wealth status and that, as such, high levels of dependency do not necessarily translate into negative health outcomes for children under age 5, based on anthropometric measures.

This cross-sectional study analysed Bangladesh Demographic and Health Survey 2011 data with the aim of investigating the prevalence of, and risk factors for, hypertension in individuals aged over 35 by rural–urban place of residence. After estimation of the stratified prevalence of hypertension by background characteristics, multivariable logistic regression analysis was conducted to calculate the adjusted odds (AORs) and 95% confidence intervals (CIs) for selected factors. Of the 7839 participants, 1830 were from urban areas and 6009 from rural areas. The overall prevalence of hypertension was 32.6% (95% CI: 30.5–34.8) in urban areas and 23.6% (95% CI: 22.5–24.7) in rural areas. The prevalence and odds of hypertension increased with increasing age, female sex, concomitant diabetes and overweight/obesity and richer wealth status in both urban and rural regions. Although residence in Khulna and Rangpur divisions and higher education level were associated with increased odds of hypertension in urban regions, this was not the case in rural regions (p>0.05). Residence in Sylhet and Chittagong divisions had lower odds of hypertension in rural regions. Furthermore, the proportions of overweight/obese, diabetic and higher wealth status participants were higher in urban than in rural regions. The prevalence and odds of hypertension were found to be associated with several common factors after stratifying by place of residence. Some of these factors are more concentrated in urban regions, so urban residents with these risk factors need to be made more aware of these in order to control hypertension in Bangladesh. Public health programmes also need to be tailored differently for urban and rural regions, based on the different distribution of these significant factors in the two areas.

Tuberculosis (TB) remains a major global public health problem that has become a crisis fuelled by HIV and the increasing occurrence of antimicrobial resistance. What has been termed the biosocial nature of TB challenges effective control of the disease. Yet, biosocial interactions involved in the persistence of TB in diverse settings are difficult to systematically account for. The recently developed framework of syndemics provides a way to capture how complex health problems result from the interactions between diseases such as HIV and TB, and harmful social conditions such as unemployment, malnutrition and substance abuse. This article advances the syndemics scholarship by examining health conditions that cluster together with TB in the Russian Federation, by eliciting a set of social processes that precipitate this clustering and exacerbate health outcomes, and by analysing interactions between these health conditions and social processes. To provide an account of this complexity, the article takes a qualitative approach and draws on the perspectives and experiences of people with TB. The results demonstrate emergence of a syndemic of stress, substance abuse, TB and HIV that is sustained by poverty, occupational insecurity, marginalization and isolation. Frictions between the narrow focus of the health care system on TB and the wider syndemic processes in which the lives of many persons with TB are embedded, contribute to poorer health outcomes and increase the risks of developing drug resistance. Finally, the article argues that the large-scale and impersonal forces become embodied as individual pathology through the crucial interface of the ways in which persons experience and make sense of these forces and pathologies. Qualitative research is needed for the adequate analysis of this biosocial complexity in order to provide a solid basis for responses to TB-centred syndemics in various settings.

Demographic research in India over the last two decades has focused extensively on fertility change and gender bias at the micro-level, and less has been done at the district level. Using data from the Census of India 1991–2011 and other sources, this paper shows the broad pattern of fertility transition and trends in the child sex ratio in India, and examines the determinants of the child sex ratio at the district level. During 1991–2011, while the Total Fertility Rate (TFR) declined by 1.2 children per woman, the child sex ratio fell by 30 points in the districts of India. However, the reduction in fertility was slower in the high-fertility compared with the low-fertility districts. The gender differential in under-five mortality increased in many districts of India over the study period. The decline in the child sex ratio was higher in the transitional compared with the low-fertility districts. The transitional districts are at higher risk of a low child sex ratio due to an increased gender differential in mortality and increase in the practice of sex-selective abortions. The sex ratio at birth and gender differential in mortality explains one-third of the variation, while region alone explains a quarter of the variation in the child sex ratio in the districts of India.

Following a suggestion that in Swansea students the downward trend of mean menarcheal age in Britain had ceased, data were collected on girls admitted to the University of Warwick over an 11-year period. There appears a slight increase in menarcheal age during the course of the study, similar to the upward trend seen in the latter part of the Swansea survey. This is not due to any change in the regional representation of the students, or in any of the other variables examined. Menarcheal age is not affected by father's socioeconomic status. It tends to be delayed in girls of larger families, while girls born later in a family of a given size have earlier menarche. Girls of more linear physique tend to have later menarcheal age.

In the developing world, little is known about the risk and precipitating factors for abortion, due to a dearth of community-based surveys. Most analyses of determinants of induced abortion consider only a small set of household and individual socio-demographic factors and treat abortion as an isolated outcome, which ignores its relationship with prior reproductive health behaviours and experiences. In this paper, data from a cross-sectional survey of abortion knowledge, attitudes and practices among 2571 currently married women of reproductive age in Rajasthan, India, were used to examine contextual-, household- and individual-level determinants of abortion. Bivariate probit models, which jointly determine the probability of pregnancy and the conditional probability of abortion, were used to reflect the probability of abortion as a result of interrelated and sequential events. Increased socioeconomic status and life-cycle factors were associated with both the probability of pregnancy and with the conditional likelihood of abortion. Women who reported personal networks were also more likely to terminate pregnancies, particularly if their network members purportedly had abortion experience. Community knowledge of sex-selective abortion also exerted a significant positive effect on the propensity to terminate a pregnancy. For rural women only, community beliefs regarding spousal consent requirements pre-abortion were also significantly associated with abortion.

Until recently there has been a paucity of factual data on the effects of the climacteric upon women's sexuality. The basic questions here are: do changes occur in sexual behaviour, sexual interest or responsiveness during the climacteric years? If so, what are the variations and how are they caused?

Two variables used extensively as a measure of sexuality are coital frequency and orgasmic frequency. Kinsey et al. (1953) showed that the degree of sexual activity remained fairly constant in unmarried women up to 55 years of age. By contrast, sexual activity in unmarried men declined gradually from puberty onwards. For married men and women they found that the frequency of sexual outlets declined during the life span. Kinsey et al. emphasized that the decreasing frequency of sexual intercourse and orgasm in marriage does not prove that the sexual capacity of the woman is influenced by her own ageing but could instead be a result of her husband's ageing. These authors were of the opinion that there is little evidence of any ageing in the sexual capacity of the female until late in her life.

To determine patterns of infant feeding and influencing factors, 131 women, interested in breast-feeding and giving birth in one hospital in British Columbia, Canada, were followed for 6 months post-partum. Data were collected from hospital records and each participant completed mail-in questionnaires when their babies were 1, 3 and 6 months old. At 6 months 3·9% were exclusively breast-feeding, 26·5% were feeding their infants breast-milk and semi-solids and 26·5% were combining breast-feeding with formula and/or semi-solids. Over 50% discontinued breast-feeding before their stated intentions. Most women had chosen to breast-feed because of benefits to the baby, and most gave up breastfeeding because of perceived insufficient milk.

This study examines whether mortality of two adjacent siblings in families is age-specific and is modified by the MCH–FP programme and fertility and mortality declines in Matlab, Bangladesh, using data for singleton births during 1977–78, 1985–86 and 1989–90 in the treatment (MCH–FP) and comparison areas. Logistic regression was used to estimate the net effects of survival status of elder siblings on mortality of younger siblings in the neonatal, postneonatal and toddler periods, controlling for birth order, previous birth interval, maternal age, education and religion, household possession of valuable items and sex of the child.

Odds of neonatal and postneonatal deaths of younger siblings were found to be higher if the elder sibling had died at the same age than if the sibling had survived infancy. Toddler mortality was lower if the elder sibling had died in infancy. The association between two siblings' mortality risks did not decline over time in either area. The results suggest that a family history of child deaths by age is important to identify when subsequent infants would be at a higher risk of dying.

In Guatemala, especially in rural areas, gender norms contribute to high fertility and closely spaced births by discouraging contraceptive use and constraining women from making decisions regarding the timing of their pregnancies and the size of their families. Community workshops for men, women and couples were conducted in 30 rural communities in Guatemala to test the hypothesis that the promotion of gender equity in the context of reproductive health will contribute to gender-equitable attitudes and strengthen the practice of family planning. Communities were randomly assigned to intervention and control groups. Pre/post surveys were conducted. Odds ratios estimated with mixed effect models to account for community-level randomization and repeated measures per participant were compared. The analyses showed statistically significant effects of the intervention on two of the three outcomes examined: gender attitudes and contraceptive knowledge. Findings regarding contraceptive use were suggestive but not significant. The results suggest that it is possible to influence both inequitable gender norms and reproductive health knowledge and, potentially, behaviours in a short span of time using appropriately designed communications interventions that engage communities in re-thinking the inequitable gender norms that act as barriers to health.